Hospital Medicine Unplugged

In this in-depth episode of Hospital Medicine Unplugged, we walk through the evidence-based hospital management of anemia in the inpatient setting—a condition that affects nearly half of hospitalized adults and directly impacts morbidity, length of stay, and readmission risk. From first-line diagnosis to tailored therapy, we cover the practical tools hospitalists need on the wards.
We start with classification and diagnostic approach:
Confirming anemia with age- and sex-specific hemoglobin cutoffs.
Morphologic classification by MCV into microcytic, normocytic, and macrocytic anemia.
Physiologic classification into hypoproliferative vs. hyperproliferative states using the reticulocyte count.
Core labs—iron studies, ferritin, transferrin saturation, vitamin B12, folate, renal function, and markers of inflammation.
How to recognize anemia of inflammation (normocytic, high ferritin, low TSAT) versus classic iron deficiency (microcytic, low ferritin, high TIBC).
Next, we move to treatment strategies:
Iron deficiency: why once-daily or alternate-day oral iron is preferred, when IV iron is indicated, and how to calculate iron deficit with the Ganzoni equation.
Anemia of inflammation/CKD: treating the underlying disease, and when to use erythropoiesis-stimulating agents.
Vitamin B12 and folate deficiency: diagnostic cutoffs, when to use IM vs. oral replacement, and urgency in cases with neurologic findings.
Transfusion: evidence for restrictive thresholds (Hb <7–8 g/dL), with exceptions for ACS, symptomatic heart failure, or other high-risk groups.
We then explore special considerations:
Hospital-acquired anemia and strategies to reduce iatrogenic blood loss.
When to suspect a gastrointestinal source of occult bleeding and the role of bidirectional endoscopy.
When to escalate to bone marrow evaluation—additional cytopenias, abnormal circulating cells, or “CRAB” features suggesting myeloma.
Finally, we highlight practical pearls on tailoring therapy to special populations: elderly adults, CKD patients, oncology patients, and those with chronic inflammatory disease. We also cover follow-up strategies, from monitoring iron indices and reticulocytes to identifying patients at risk of relapse.
This episode delivers concise, guideline-driven, practical medicine—no fluff, just the evidence you need for safe, effective inpatient management of anemia.

In this in-depth episode of Hospital Medicine Unplugged, we walk through the evidence-based hospital management of gram-positive bacteremia, one of the most critical scenarios hospitalists face. From first-line antibiotic selection to workup and follow-up, we cover the full spectrum of care needed on the wards.
We start with antibiotic therapy—why cefazolin or antistaphylococcal penicillins (nafcillin/oxacillin) remain the gold standard for MSSA, and how vancomycin and daptomycin are the pillars of MRSA treatment. We also review the clinical implications of an elevated vancomycin MIC and when to switch therapy.
Next, we move to diagnostic evaluation:
Why every patient with S. aureus bacteremia requires echocardiography.
How to choose between TTE and TEE depending on risk and persistence of bacteremia.
When to pursue additional imaging for metastatic infection.
We then discuss vascular access and therapy duration—when to use a PICC versus a midline, how long to treat uncomplicated vs. complicated bacteremia, and what criteria must be met before considering an oral step-down approach.
Special focus is given to unique populations and challenges: managing patients with prosthetic devices, immunosuppression, or recurrent bacteremia, and tailoring therapy when standard regimens are not tolerated.
Finally, we highlight practical pearls on source control, monitoring for relapse, and avoiding common pitfalls such as underestimating the risk of endocarditis or prematurely narrowing therapy.
This episode delivers concise, guideline-driven, practical medicine—no fluff, just the evidence you need for safe, effective inpatient management of gram-positive bacteremia.

In this in-depth episode of Hospital Medicine Unplugged, we walk through the evidence-based hospital management of pulmonary embolism (PE) and deep vein thrombosis (DVT). From bedside diagnosis to long-term follow-up, we cover the full spectrum of care hospitalists need on the wards.
We start with diagnosis and risk stratification—how to use Wells criteria, D-dimer, ultrasound, and CT angiography effectively, and when imaging can safely be avoided. For PE, we break down high-risk (massive), intermediate-risk (submassive), and low-risk categories, and how these guide management.
Next, we move to acute therapy:
Anticoagulation as the cornerstone of treatment, with DOACs as first-line for most patients.
When to reach for LMWH or UFH, including cancer, pregnancy, renal impairment, and hemodynamic instability.
Thrombolysis for massive PE, and the evolving role of catheter-directed interventions.
Why IVC filters are rarely indicated.
We then explore treatment duration, from fixed 3-month courses for provoked VTE to indefinite therapy for unprovoked or persistent risk factors, including the use of reduced-dose DOACs for extended prevention.
Special focus is given to outpatient management, where carefully selected low-risk PE and DVT patients can be safely discharged using validated tools like the Hestia criteria and sPESI score, supported by recent trials and systematic reviews.
Finally, we highlight special populations—patients with cancer, pregnancy, or advanced renal disease—where therapy must be tailored to unique risks and physiology. We also cover supportive care, prevention of post-thrombotic syndrome, and follow-up for chronic thromboembolic pulmonary hypertension.
This episode delivers concise, guideline-driven, practical medicine—no fluff, just the evidence you need for safe, effective inpatient management of PE and DVT.

In this episode of Hospital Medicine Unplugged, we explore the evolving science and clinical realities of community-acquired pneumonia (CAP) in hospitalized adults. Drawing from leading journals such as The New England Journal of Medicine and JAMA, we walk through practical approaches every hospitalist needs when managing pneumonia on the wards.
We start with diagnosis: recognizing new infiltrates on chest imaging in the right clinical context, and how severity scoring tools like the Pneumonia Severity Index (PSI) or ATS/IDSA criteria should guide triage—but always supplemented with bedside judgment.
Next, we dive into treatment strategies:
When to use a β-lactam plus macrolide combination versus fluoroquinolone monotherapy.
How to broaden empiric coverage for MRSA and Pseudomonas in high-risk patients.
Evidence behind macrolides’ potential immunomodulatory effects in severe CAP.
Why vancomycin + piperacillin/tazobactam should be used cautiously given nephrotoxicity risks.
We also highlight microbiology and diagnostics: pathogen yield remains low, but blood/sputum cultures, PCR panels, and procalcitonin can help guide therapy in select patients. Viral pathogens (influenza, SARS-CoV-2, rhinovirus) are increasingly recognized, often in coinfection with bacteria.
Finally, we discuss special considerations:
Corticosteroids in severe CAP.
Transitioning safely to oral therapy.
Radiologic clues for atypical pathogens (Mycoplasma, Chlamydia, Legionella).
The importance of prevention through vaccination.
Whether you’re on service covering a busy inpatient unit or preparing for boards, this episode blends guideline-based recommendations with real-world pearls—helping you feel more confident in diagnosing, treating, and preventing complications from CAP.